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Final Report Implemented by Final Report Assessment of Climate Change-related Risks and Vulnerabilities in the Health Sector in Togo All rights reserved. The content of this material produced by EPOS and adelphi and the material itself are subject to copyright. Third party contributions are marked as such. This publication may be reproduced in whole or part in any form whatsoever only for educational and non-profit purposes provided the source is acknowledged and referenced. This publication may not be resold or used for any commercial purpose without the prior written permission of the sponsors or authors. Suggested Citation Schmuck, Hanna; Stefan Kienberger, Claire Belluard et Olga Bassong 2019: Final Report. Germany: EPOS/adelphi commissioned by GIZ. Publishers: EPOS Health Management GmbH Hindenburgring 18 61348 Bad Homburg https://www.epos.de adelphi consult GmbH Alt-Moabit 91 10559 Berlin www.adelphi.de Authors: Dr Hanna Schmuck, Dr Stefan Kienberger, Claire Belluard, Dr Olga Bassong Contribution: Markus Kerschbaumer Commissioned by: German Cooperation through its Project on Health System Strengthening – Sexual and Reproductive Health and Rights (ProSanté) implemented by GIZ Page Layout: Claire Belluard Photo Credits: Hanna Schmuck Status: January 2020 © 2019 GIZ I Acknowledgements The EPOS/adelphi Consortium would like to sincerely thank all those who have supported the assessment since its inception and without whom this report would not have been possible. First, we express our gratitude to GIZ ProSanté project team and its partners, in particular the Minister of Health and Public Hygiene and the Minister of Environment, Sustainable Development and Nature Protection, who have kindly accepted to initiate and support this study. Beyond this report, the EPOS/adelphi Consortium requests the support of GIZ/German Cooperation and its technical partners for the implementation of the findings of the assessment. Our appreciation, in particular, goes to Alina BERENDSEN and Lisa DIARRA (GIZ ProSanté), to Dr Sossinou AWOUSSI (Permanent Secretary of the MSHP), to Dr Essotoma BEWELI (Director General of Health Action of the MSPH), to Dr Romain TCHAMDJA (Advisor to the MSHP), to Komlan AYITE (Director of Basic Hygiene and Sanitation at the MSHP), to Didier BAMALI (National Focal Point of the National Adaptation Plan, Division of Environment at the MEDDPN), to Nana DARE (Directorate general of National Meteorology at the MIT) and to Komlan EDOU (Coordinator of the 4th National Communication at the MEDDPN). The EPOS/adelphi Consortium team of consultants thanks Markus KERSCHBAUMER (Spatial Services) for his important contribution to the outcome mapping. Special thanks should also be given to Sébastien OSTERRIETH (consultant based in Togo) for his technical support in the collection and analysis of the data and the drafting of this report. We are also very grateful to Professor Yao KASSANKOGNO for facilitating the workshops and documenting their outcomes, as well as Paul BANKA and Joseph KOGBE for developing studies that served as baseline for this analysis. The success of the use and dissemination of the results, as well as the implementation of the recommendations of the adaptation measures, will ultimately depend on their ownership by the national stakeholders. They will have to take into account the need to integrate climate change adaptation into the strategies and planning of the health sector, but also the other relevant sectors involved in the well- being of the Togolese people. Dr Hanna SCHMUCK (Team Lead), Dr Stefan KIENBERGER (GIS Expert), Dr Olga BASSONG (Health Expert), Claire BELLUARD (adelphi) and Martina EIFRIG (EPOS) II List of Abbreviations and Acronyms AR5 IPCC Fifth Assessment Report BIO Biological Susceptibility CDD Consecutive Dry Days CHW Community Health Workers CORDEX Coordinated Regional Climate Downscaling Experiment DALY Disability-Adjusted Life Year DHAB Directorate of Basic Hygiene and Sanitation DHIS2 District Health Information Software 2 GCMs Global Climate Models GIS Geographic Information System GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit IFRC International Federation of Red Cross and Red Crescent Societies IPCC Intergovernmental Panel on Climate Change LLINs Long-Lasting insecticidal Nets LTS Length of Transmission Season MEDDPN Ministry of Environment, Sustainable Development and Nature Protection (Formerly MERF) MERF Ministry of Environment and Forest Resources (Now MEDDPN) MIT Ministry of Infrastructures and Transport MSHP Ministry of Health and Public Hygiene NAPCCA National Action Plan for Climate Change Adaptation NCCAP National Climate Change Adaptation Plan 2017–2021 NCSD National Council for Sustainable Development PHUs Peripheral Health Units PR10 Annual count of days when precipitation ≥ 10 mm ProSanté Project on Health System Strengthening – Sexual and Reproductive Health and Rights QALY Quality-Adjusted Life Year QUIBB Survey on Combined Questionnaire of Basic Welfare Indicators (Survey published by the Ministry of Development Planning & the National Institute for Statistics, Economic and Demographic Studies) RCMs Regional Climate Models RCP Representative Concentration Pathway SMHI Swedish Meteorological and Hydrological Institute SUS Generic Susceptibility Tmax Maximum Temperature UNFCCC United Nations Framework Convention on Climate Change III Executive Summary According to the latest report of the Intergovernmental Panel on Climate Change (IPCC), hereinafter referred to as ‘AR5’, climate change undeniably affects human health. On the one hand, it increases the frequency and intensity of natural disasters (the direct cause of death and injuries) and, on the other hand, it causes temperature variation and precipitation that leads to the aggravation of climate-sensitive diseases. In Togo, the threat of climate change to health has been confirmed by official documents. Studies of the Ministry of Environment, Sustainable Development and Nature Protection (formerly known as the Ministry of Environment and Forest Resources), have concluded that effects of climate change contribute to the continued spread of vector-borne, water-borne and infectious diseases (MERF 2015 a and b). This is all the more problematic for Togo which does not yet have a climate change adaptation strategy specifically for the health sector. Thus, in order to assess the health sector’s vulnerability to the effects of climate change, the Ministry of Health and Public Hygiene requested the support of GIZ through the Project on Health System Strengthening – Sexual and Reproductive Health and Rights (ProSanté). Through the ProSanté Project, funded by the German Federal Ministry for Economic Cooperation and Development (BMZ), which is being implemented since September 2017 in Lomé and Kara, GIZ operates in the health sector in Togo, in collaboration with the MSHP. ProSanté Project objectives include enhancing the resilience to the effects of climate change, thereby contributing to the broader goal of strengthening the Togolese health care system as a whole. It is in this regard that an assessment of the health sector vulnerability to the effects of climate change was commissioned and conducted by the Consortium EPOS and adelphi firms, in collaboration with national stakeholders. The overall objective of this study is to identify and assess the health risks arising from the effects of climate change, as well as the adaptive capacity of the health system. The findings of this assessment have led to the mapping of climate-sensitive diseases and can serve as a reference for the development of a climate change adaptation plan for the health sector with a view to strengthening the capacities of the health systems in order to protect and improve the health of the population for responses to instability and climate change. The assessment was conducted by a team of experts of EPOS/adelphi Consortium: Dr Hanna Schmuck as Team Lead/Expert in Risk and Vulnerability Assessment, Dr Stefan Kienberger as Expert in Geographic Information System, Dr Olga Bassong as Health Expert and Claire Belluard as Technical Support person. The approach and methodology of the assessment are based on the concepts of risk and vulnerability assessment developed in The Vulnerability Sourcebook (GIZ 2014) and the Risk Supplement to the Vulnerability Sourcebook (GIZ 2017). The core element of the approach is developing impact chains, a tool which serves to identify and visualize all the factors that, through a chain of causal relationships, lead to the risk – the ultimate purpose of the assessment. In the AR5 conceptual framework, risk is determined by three components: hazard, exposure and vulnerability, which are further made up of multiple factors. During the course of this assessment, a participatory process involving representatives of institutions related to the health sector in Togo identified three major risks and their respective impact chains (see Annex 1). In the context of this assessment, the three risks are three climate-sensitive diseases, namely malaria, respiratory infections/conditions and meningitis. A three-day field visit (in the Maritime and Kara regions) was also carried out to check the factors of the impact chains and to get an overview of the capacities of local facilities, in particular with regard to the recommendations for adaptation measures. Subsequently, the team collected the available quantitative data to define the indicators chosen to measure the risk factors identified in the impact chains. The selection of indicators
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